Hepatitis A Cases in Pennsylvania Rise to 510
Monday November 17, 2003
The number of confirmed Hepatis A cases in Western Pennsylvania have exceeded 500, including 3 deaths, in what has now become the largest hepatitis A outbreak in U.S. history, according to the Centers for Disease Control and Prevention. As a precaution, many restaurant chains are now removing green onions from their menus nationwide.
The exact cause of the Hepatitis A infection is still not known, but investigators are looking closely at green onions as a possible source of the outbreak at the Beaver County Chi-Chi's Mexican Restaurant. Since outbreaks of hepatitis A in Tennessee, North Carolina and Georgia in September were linked to green onions, the Food and Drug Administration issued a recommendation on Saturday that green onions be thoroughly cooked to avoid infection. A number of restaurant chains, including Taco Bell, are now joining Chi-Chi's in removing green onions from menu items as a precaution.
Health officials in Pennsylvania said the number of Hepatitis A infections is likely to continue rising through this week, peaking about November 22, 2003. While the Chi-Chi's restaurant has been closed since November 2, the virus can take nearly a month to exhibit its early flu-like symptoms. Officials from the Pennsylvania Department of Health are optimistic, however, that the antibody (immune globulin) injections given to more than 8,500 people in the past two weeks will reduce the number of new infections.
Federal officials describe the outbreak as the largest in U.S. history, noting that hepatitis A outbreaks contained to a single restaurant typically impact between 25 and 200 people. The largest hepatitis A outbreak on record occured in 1988 when almost 300,000 people in China ate contaminated clams. In 1997, frozen strawberries caused 262 people in five states to become infected with the virus. Last month, a Hepatitis A outbreak in several restaurants in Georgia, North Carolina, and Tennessee was linked to shipments of green onions.
Hepatitis A is spread by eating something contaminated with the feces of someone with hepatitis A, according to the Centers for Disease Control and Prevention. Infection with Hepatitis A typically causes a flu-like illness with yellowing of the skin, nausea, and vomiting, fatigue and diarrhea. The disease usually clears up in about two months, and most patients recover with no serious long-term health problems.
HEPATITIS A QUESTIONS & ANSWERS:
What can I do to decrease my risk of infection from hepatitis A caused by contaminated green onions?
Cook all raw green onions thoroughly before eating them. This minimizes the risk of illness by reducing or eliminating the virus. You can also avoid eating raw or lightly cooked green onions and, if you eat in a restaurant, you may want to request that raw or lightly cooked green onions not be added to your food.
Should additional precautions be taken by people with chronic liver disease or weakened immune systems such as patients undergoing chemotherapy or AIDS patients?
People with chronic liver disease or weakened immune systems are not more likely to acquire hepatitis A. However, persons with these chronic illnesses sometimes have a more severe form of hepatitis A. People with chronic liver disease or weakened immune systems should consider avoiding raw or undercooked green onions until the cause of green onion contamination has been identified and corrected. All individuals with chronic liver disease should get a hepatitis A vaccination (see below).
What caused the outbreak of hepatitis A in the Pittsburgh area?
The State of Pennsylvania, the Centers for Disease Control and Prevention (CDC) and FDA are working together to investigate this outbreak. As of November 17, 2003, the investigation is not finished, and it is not yet known what caused this outbreak. Investigators are now trying to determine if the outbreak was caused by a contaminated food such as raw or undercooked green onions.
Has the FDA asked the restaurant industry to do anything in response to these outbreaks?
Yes. FDA has informed the restaurant industry of the association of hepatitis A with raw or undercooked green onions in recent outbreaks so that restaurants can take actions to protect their customers. Many restaurants, especially in the Pittsburgh area, have voluntarily removed green onions from their menu items as a precautionary measure.
What are the symptoms of hepatitis A?
The average incubation period for hepatitis A is 28 days (range: 15–50 days). This means that symptoms of hepatitis A develop within 50 days of exposure. Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Adults are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. There is no chronic infection with the hepatitis A virus, as there is with Hepatitis B and C.
How serious is hepatitis A?
Most people with hepatitis A make a full recovery and will never get hepatitis A again. However, in rare instances (an average of 3 in every 1000 reported cases), hepatitis A can be fatal.
What should I do if I recently ate food containing raw or lightly cooked green onions?
If you who have recently eaten raw or lightly cooked green onions and feel well, you only need to monitor your health. If you are experiencing symptoms that might be hepatitis A, then consult your health care provider.
Is there a test for hepatitis A?
Yes, there is a blood test for hepatitis A, called an IgM anti-HAV. However, the only people who need this test are those who are showing symptoms of hepatitis A. Persons who feel well should not be tested, even if they recently ate green onions.
What is immune globulin (often called IG or ISG) and who should receive it?
Immune globulin is a preparation of antibodies that can be given before exposure to provide short-term protection against hepatitis A to reduce the risk of infection among persons who have recently been exposed to hepatitis A. For maximum protection immune globulin must be given within 2 weeks after exposure. People who have recently eaten green onions do not need to get immune globulin unless they have been specifically exposed within the previous 2 weeks to individuals or food involved in an outbreak and believed by public health officials to have been potentially contaminated.
Are there treatments for hepatitis A?
There is no medication that treats hepatitis A. Some patients with hepatitis A may need to be hospitalized to treat dehydration or liver complications. In rare cases, a liver transplant may be necessary.
Is there a vaccine for hepatitis A?
Yes, but it should be given before an exposure to work most effectively. Hepatitis A vaccine has been licensed in the United States for use in persons 2 years of age and older. The vaccine is recommended for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The CDC does not recommend that persons who have eaten green onions get vaccinated, unless a healthcare professional recommends that they get vaccinated because of other risk factors for hepatitis A.
Have there been other recent outbreaks of hepatitis A caused by contaminated food in the U.S.? Have these outbreaks been associated with raw green onions?
Yes. Hepatitis A outbreaks associated with raw or undercooked green onions served in restaurants occurred in Tennessee, North Carolina and Georgia in September. The source of the green onions from the Tennessee outbreak appears to be Mexico. The agency has been in consultation with Mexican authorities to obtain their assistance in assessing the situation. In addition, the FDA is monitoring certain import entries of green onions for evidence of potential contamination.
Adapted from information provided by the FDA
MORE HEPATITIS A RESOURCES:
Hepatitis A Vaccine & Immune Globulin
CDC - Viral Hepatitis A
Pennsylvania Department of Health
The exact cause of the Hepatitis A infection is still not known, but investigators are looking closely at green onions as a possible source of the outbreak at the Beaver County Chi-Chi's Mexican Restaurant. Since outbreaks of hepatitis A in Tennessee, North Carolina and Georgia in September were linked to green onions, the Food and Drug Administration issued a recommendation on Saturday that green onions be thoroughly cooked to avoid infection. A number of restaurant chains, including Taco Bell, are now joining Chi-Chi's in removing green onions from menu items as a precaution.
Health officials in Pennsylvania said the number of Hepatitis A infections is likely to continue rising through this week, peaking about November 22, 2003. While the Chi-Chi's restaurant has been closed since November 2, the virus can take nearly a month to exhibit its early flu-like symptoms. Officials from the Pennsylvania Department of Health are optimistic, however, that the antibody (immune globulin) injections given to more than 8,500 people in the past two weeks will reduce the number of new infections.
Federal officials describe the outbreak as the largest in U.S. history, noting that hepatitis A outbreaks contained to a single restaurant typically impact between 25 and 200 people. The largest hepatitis A outbreak on record occured in 1988 when almost 300,000 people in China ate contaminated clams. In 1997, frozen strawberries caused 262 people in five states to become infected with the virus. Last month, a Hepatitis A outbreak in several restaurants in Georgia, North Carolina, and Tennessee was linked to shipments of green onions.
Hepatitis A is spread by eating something contaminated with the feces of someone with hepatitis A, according to the Centers for Disease Control and Prevention. Infection with Hepatitis A typically causes a flu-like illness with yellowing of the skin, nausea, and vomiting, fatigue and diarrhea. The disease usually clears up in about two months, and most patients recover with no serious long-term health problems.
HEPATITIS A QUESTIONS & ANSWERS:
What can I do to decrease my risk of infection from hepatitis A caused by contaminated green onions?
Cook all raw green onions thoroughly before eating them. This minimizes the risk of illness by reducing or eliminating the virus. You can also avoid eating raw or lightly cooked green onions and, if you eat in a restaurant, you may want to request that raw or lightly cooked green onions not be added to your food.
Should additional precautions be taken by people with chronic liver disease or weakened immune systems such as patients undergoing chemotherapy or AIDS patients?
People with chronic liver disease or weakened immune systems are not more likely to acquire hepatitis A. However, persons with these chronic illnesses sometimes have a more severe form of hepatitis A. People with chronic liver disease or weakened immune systems should consider avoiding raw or undercooked green onions until the cause of green onion contamination has been identified and corrected. All individuals with chronic liver disease should get a hepatitis A vaccination (see below).
What caused the outbreak of hepatitis A in the Pittsburgh area?
The State of Pennsylvania, the Centers for Disease Control and Prevention (CDC) and FDA are working together to investigate this outbreak. As of November 17, 2003, the investigation is not finished, and it is not yet known what caused this outbreak. Investigators are now trying to determine if the outbreak was caused by a contaminated food such as raw or undercooked green onions.
Has the FDA asked the restaurant industry to do anything in response to these outbreaks?
Yes. FDA has informed the restaurant industry of the association of hepatitis A with raw or undercooked green onions in recent outbreaks so that restaurants can take actions to protect their customers. Many restaurants, especially in the Pittsburgh area, have voluntarily removed green onions from their menu items as a precautionary measure.
What are the symptoms of hepatitis A?
The average incubation period for hepatitis A is 28 days (range: 15–50 days). This means that symptoms of hepatitis A develop within 50 days of exposure. Persons with hepatitis A virus infection may not have any signs or symptoms of the disease. Adults are more likely to have symptoms than children. If symptoms are present, they usually occur abruptly and may include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Symptoms usually last less than 2 months; a few persons are ill for as long as 6 months. There is no chronic infection with the hepatitis A virus, as there is with Hepatitis B and C.
How serious is hepatitis A?
Most people with hepatitis A make a full recovery and will never get hepatitis A again. However, in rare instances (an average of 3 in every 1000 reported cases), hepatitis A can be fatal.
What should I do if I recently ate food containing raw or lightly cooked green onions?
If you who have recently eaten raw or lightly cooked green onions and feel well, you only need to monitor your health. If you are experiencing symptoms that might be hepatitis A, then consult your health care provider.
Is there a test for hepatitis A?
Yes, there is a blood test for hepatitis A, called an IgM anti-HAV. However, the only people who need this test are those who are showing symptoms of hepatitis A. Persons who feel well should not be tested, even if they recently ate green onions.
What is immune globulin (often called IG or ISG) and who should receive it?
Immune globulin is a preparation of antibodies that can be given before exposure to provide short-term protection against hepatitis A to reduce the risk of infection among persons who have recently been exposed to hepatitis A. For maximum protection immune globulin must be given within 2 weeks after exposure. People who have recently eaten green onions do not need to get immune globulin unless they have been specifically exposed within the previous 2 weeks to individuals or food involved in an outbreak and believed by public health officials to have been potentially contaminated.
Are there treatments for hepatitis A?
There is no medication that treats hepatitis A. Some patients with hepatitis A may need to be hospitalized to treat dehydration or liver complications. In rare cases, a liver transplant may be necessary.
Is there a vaccine for hepatitis A?
Yes, but it should be given before an exposure to work most effectively. Hepatitis A vaccine has been licensed in the United States for use in persons 2 years of age and older. The vaccine is recommended for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The CDC does not recommend that persons who have eaten green onions get vaccinated, unless a healthcare professional recommends that they get vaccinated because of other risk factors for hepatitis A.
Have there been other recent outbreaks of hepatitis A caused by contaminated food in the U.S.? Have these outbreaks been associated with raw green onions?
Yes. Hepatitis A outbreaks associated with raw or undercooked green onions served in restaurants occurred in Tennessee, North Carolina and Georgia in September. The source of the green onions from the Tennessee outbreak appears to be Mexico. The agency has been in consultation with Mexican authorities to obtain their assistance in assessing the situation. In addition, the FDA is monitoring certain import entries of green onions for evidence of potential contamination.
Adapted from information provided by the FDA
MORE HEPATITIS A RESOURCES:
Hepatitis A Vaccine & Immune Globulin
CDC - Viral Hepatitis A
Pennsylvania Department of Health
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